National expert consensus on the diagnosis and surgical treatment of diabetic foot ulcers complicated with lower extremity vasculopathy (2024 version)
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摘要: 糖尿病足溃疡合并下肢血管病变具有发病率高、愈合缓慢、预后差的特点，如不经规范治疗易导致截肢甚至危及生命。针对合并下肢血管病变的治疗对改善糖尿病足溃疡的愈合进程至关重要，在临床实践中逐渐得到重视。近年来，关于糖尿病足溃疡合并下肢血管病变的临床研究已见诸多报道，为了进一步规范临床诊疗，由中国老年医学学会烧创伤分会、中华医学会烧伤外科学分会、中国医师协会创面修复专业委员会牵头的专家组共同审议并编写了《糖尿病足溃疡合并下肢血管病变的外科诊疗全国专家共识（2024版）》。该共识以文献证据为基础，内容涵盖了糖尿病足溃疡合并下肢血管病变的疾病特征、临床诊疗循证证据以及新技术和新治疗方法的应用，旨在为临床工作者提供关于糖尿病足溃疡合并下肢血管病变最佳筛查和诊疗方法的明确指导，希望为从事糖尿病足创面治疗的医务人员提供规范性的临床实践依据。Abstract: Diabetic foot ulcers complicated with lower extremity vasculopathy possess the characteristics of high incidence, slow healing, and poor prognosis, which may eventually lead to amputation or even life-threatening if not treated properly. The treatment of complicated lower extremity vasculopathy is vital to improve the healing process of diabetic foot ulcers, which has gradually received attention in clinical practice. Recently, a number of clinical trials on diabetic foot ulcers complicated with lower extremity vasculopathy were reported. In order to further standardize the clinical diagnosis and treatment of diabetic foot ulcers complicated with lower extremity vasculopathy, an expert group headed by Burns and Trauma Branch of Chinese Geriatrics Society, Chinese Burn Association, and Wound Repair Professional Committee of Chinese Medical Doctor Association deliberated and compiled the National expert consensus on the diagnosis and surgical treatment of diabetic foot ulcers complicated with lower extremity vasculopathy (2024 version) together. This consensus is based on evidences from the literature, covers the disease characteristics, evidence-based evidence of clinical diagnosis and treatment, as well as the application of new technologies and new treatment approaches of diabetic foot ulcers complicated with lower extremity vasculopathy. The goal of this consensus is to provide clear guidance to practitioners on the best approaches for screening, diagnosing, and treating diabetic foot ulcers complicated with lower extremity vasculopathy in individuals, hoping to provide a normative clinical practice basis for medical staff engaged in the treatment of diabetic foot wounds.
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Key words:
- Diabetic foot /
- Diabetic angiopathies /
- Peripheral arterial disease /
- Microcirculation /
- Amputation /
- Wound repair /
- Expert consensus
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1 糖尿病足溃疡合并下肢血管病变的评估和分级方法
注：CTA为CT血管成像，MRA为磁共振血管成像，DSA为数字减影血管造影，SINBAD为部位、缺血、神经病变、细菌感染、面积、深度，TcPO2为经皮氧分压，WIfI为创面、缺血和足感染；1 mmHg=0.133 kPa
表1 2009版牛津大学循证医学中心证据分级标准
表1. Oxford Centre for Evidence-Based Medicine: levels of evidence (2009)
证据级别 定义 A 1a 基于同质RCT的系统评价 1b 单个RCT研究 1c 全或无病案研究 B 2a 基于同质队列研究的系统评价 2b 单个队列研究（包括低质量RCT，如随访率<80%） 2c 结果研究或生态学研究 3a 基于同质病例对照研究的系统评价 3b 病例对照研究 C 4 单个病例系列研究（包括低质量队列研究和病例对照研究） D 5 基于未经严格论证的专家意见 注：RCT为随机对照试验 
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表2 针对糖尿病足溃疡评估的SINBAD分级
表2. SINBAD classification for diabetic foot ulcer assessment
类型 定义 评分（分） 部位 前足掌 0 中、后足掌 1 缺血 足部血运正常，至少可触及1处动脉搏动 0 有足部血流减少的临床证据 1 神经病变 保护性感觉存在 0 保护性感觉缺失 1 细菌感染 无 0 有 1 面积 溃疡面积<1 cm 2 0 溃疡面积≥1 cm 2 1 深度 溃疡局限在皮肤和皮下组织 0 溃疡深达肌肉、肌腱或更深 1 注：表格引自文献［ 7］；SINBAD为部位、缺血、神经病变、细菌感染、面积、深度
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表3 针对糖尿病足溃疡患者的WIfI分级各组合的1年内截肢风险等级
表3. The risk grade of amputation within one year for each combination of WIfI classification for patients with diabetic foot ulcers
创面等级 0级缺血 1级缺血 2级缺血 3级缺血 0级足感染 1级足感染 2级足感染 3级足感染 0级足感染 1级足感染 2级足感染 3级足感染 0级足感染 1级足感染 2级足感染 3级足感染 0级足感染 1级足感染 2级足感染 3级足感染 0 极低 极低 低 中等 极低 低 中等 高 低 低 中等 高 低 中等 中等 高 1 极低 极低 低 中等 极低 低 中等 高 低 中等 高 高 中等 中等 高 高 2 低 低 中等 中等 中等 中等 高 高 中等 高 高 高 高 高 高 高 3 中等 中等 高 高 高 高 高 高 高 高 高 高 高 高 高 高 注：WIfI为创面、缺血和足感染
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表4 针对糖尿病足溃疡患者的WIfI分级各组合的血运重建获益等级
表4. The benefit grade of revascularization for each combination of WIfI classification for patients with diabetic foot ulcers
创面等级 0级缺血 1级缺血 2级缺血 3级缺血 0级足感染 1级足感染 2级足感染 3级足感染 0级足感染 1级足感染 2级足感染 3级足感染 0级足感染 1级足感染 2级足感染 3级足感染 0级足感染 1级足感染 2级足感染 3级足感染 0 极低 极低 极低 极低 极低 低 低 中等 低 低 中等 中等 中等 高 高 高 1 极低 极低 极低 极低 低 中等 中等 高 中等 高 高 高 高 高 高 高 2 极低 极低 极低 极低 中等 中等 高 高 高 高 高 高 高 高 高 高 3 极低 极低 极低 极低 中等 中等 中等 高 高 高 高 高 高 高 高 高 注：WIfI为创面、缺血和足感染
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糖尿病足溃疡合并下肢血管病变的外科诊疗全国专家共识（2024版）-附件表格.docx
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